Evolving Management of Adhesive Small Bowel Obstruction in Paediatric Surgery
Keywords:
pediatric surgery, adhesive obstruction, small bowel, non‑operative, laparoscopy, contrast challenge, recurrenceAbstract
Adhesive small bowel obstruction (ASBO) is a frequent late complication of paediatric abdominal surgery and an important cause of morbidity, repeated admissions, and re‑operations in children. Recent paediatric data suggest that most haemodynamically stable children without signs of strangulation can be safely managed non‑operatively, although a significant minority will eventually require timely surgery,,. Adult‑derived protocols using water‑soluble contrast have transformed ASBO decision‑making, but emerging paediatric studies show that enteral contrast may not reduce operative rates or length of stay to the same extent in children,. Laparoscopic adhesiolysis is increasingly used in selected paediatric patients and appears to reduce complications and length of stay compared with laparotomy, but carries a higher risk of bowel injury in difficult cases and remains underused in very young children,,,. This article reviews current evidence on conservative versus operative management, decision‑making tools, and minimally invasive approaches for paediatric ASBO, highlighting areas where adult practice cannot be directly extrapolated.
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